Assessment and Diagnostic Findings PDF

10/24/23, 3:22 PM Realizeit for Student Assessment and Diagnostic Findings The diagnostic evaluation includes a detailed history, a physical assessment of the head and neck, and a complete neurologic examination. Headaches may manifest differently in the same person over the course of a lifetime,...

10/24/23, 3:22 PM Realizeit for Student Assessment and Diagnostic Findings The diagnostic evaluation includes a detailed history, a physical assessment of the head and neck, and a complete neurologic examination. Headaches may manifest differently in the same person over the course of a lifetime, and the same type of headache may manifest differently from patient to patient. The health history focuses on assessing the headache itself, with emphasis on the factors that precipitate or provoke it. The patient is asked to describe the headache in their own words. Because headache is often the presenting symptom of a wider variety of physiologic and psychological disturbances, a general health history is an essential component of the patient database. Therefore, questions addressed in the health history should cover major medical and surgical illness as well as a body systems review. The medication history can provide insight into the patient’s overall health status and indicate medications that may be provoking headaches. Antihypertensive agents, diuretic medications, antiinflammatory agents, and monoamine oxidase (MAO) inhibitors are a few of the categories of medications that can provoke headaches. Daily use of over-the-counter or prescribed pain medications for 8 to 10 days out of a month can lead to a chronic headache due to medication overuse (Comerford & Durkin, 2020). Emotional factors can play a role in precipitating headaches. Stress is thought to be a major initiating factor in migraine headaches; therefore, sleep patterns, level of stress, recreational interests, appetite, emotional problems, and family stressors are relevant. There is a strong familial tendency for headache disorders, and a positive family history may help in making a diagnosis. A direct relationship may exist between exposure to toxic substances and headache. Careful questioning may uncover chemicals to which a worker has been exposed. Under the Right-to-Know Law, employees have access to the material safety data sheets (commonly referred to as MSDSs) for all substances with which they come in contact in the workplace. The occupational history also includes assessment of the workplace as a possible source of stress and for a possible ergonomic basis of muscle strain and headache. A complete description of the headache itself is crucial. The nurse reviews the age at onset of headaches; this particular headache’s frequency, location, and duration; the type of pain; factors that relieve and precipitate the event; and associated symptoms (Starling, 2018). The data obtained should include the patient’s own words about the headache in response to the following questions: What is the location? Is it unilateral or bilateral? Does it radiate? What is the quality—dull, aching, steady, boring, burning, intermittent, continuous, paroxysmal? How many headaches occur during a given period of time? What are the precipitating factors, if any—environmental (e.g., sunlight, weather change), foods, exertion, other? https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 1/5 10/24/23, 3:22 PM Realizeit for Student What makes the headache worse (e.g., coughing, straining)? What time (day or night) does it occur? How long does a typical headache last? Are there any associated symptoms, such as facial pain, lacrimation (excessive tearing), or scotomas (blind spots in the field of vision)? What usually relieves the headache (aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs], ergot preparation, food, heat, rest, neck massage)? Does nausea, vomiting, weakness, or numbness in the extremities accompany the headache? Does the headache interfere with daily activities? Do you have any allergies? Do you have insomnia, poor appetite, loss of energy? Is there a family history of headache? What is the relationship of the headache to your lifestyle or physical or emotional stress? What medications are you taking? Diagnostic testing often is not helpful in the investigation of headache, because usually there are few objective findings. In patients who demonstrate abnormalities on the neurologic examination, CT scan, cerebral angiography, or MRI scan may be used to detect underlying causes, such as tumor or aneurysm. Electromyography (EMG) may reveal a sustained contraction of the neck, scalp, or facial muscles. Laboratory tests may include complete blood count, erythrocyte sedimentation rate, electrolytes, glucose, creatinine, and thyroid hormone levels. A complete description of the headache itself is crucial. The nurse reviews the age at onset of headaches; this particular headache's frequency, location, and duration; the type of pain; factors that relieve and precipitate the event; and associated symptoms. The data obtained should include the patient's own words about the headache in response to the following questions: What is the location? Is it unilateral or bilateral? Does it radiate? What is the quality—dull, aching, steady, boring, burning, intermittent, continuous, paroxysmal? How many headaches occur during a given period of time? What are the precipitating factors, if any—environmental (e.g., sunlight, weather change), foods, exertion, other? What makes the headache worse (e.g., coughing, straining)? What time (day or night) does it occur? How long does a typical headache last? Are there any associated symptoms, such as facial pain, lacrimation (excessive tearing), or scotomas (blind spots in the field of vision)? What usually relieves the headache (aspirin, nonsteroidal anti-inflammatory drugs, ergot preparation, food, heat, rest, neck massage)? Does nausea, vomiting, weakness, or numbness in the extremities accompany the headache? Does the headache interfere with daily activities? Do you have any allergies? Do you have insomnia, poor appetite, loss of energy? Is there a family history of headache? What is the relationship of the headache to your lifestyle or physical or emotional stress? What medications are you taking? https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 2/5 10/24/23, 3:22 PM Realizeit for Student Diagnostic testing often is not helpful in the investigation of headache because usually there are few objective findings. In patients who demonstrate abnormalities on the neurologic examination, CT scan, cerebral angiography, or MRI scan may be used to detect underlying causes, such as tumor or aneurysm. Electromyography (EMG) may reveal a sustained contraction of the neck, scalp, or facial muscles. Laboratory tests may include complete blood count, erythrocyte sedimentation rate, electrolytes, glucose, creatinine, and thyroid hormone levels. Prevention Prevention begins by having the patient avoid specific triggers that are known to initiate the headache syndrome. Preventive medical management of migraine involves the daily use of one or more agents that are thought to block the physiologic events leading to an attack. Treatment regimens vary greatly, as do patient responses; therefore, close monitoring is indicated. Alcohol, nitrites, vasodilators, and histamines may precipitate cluster headaches. Elimination of these factors helps prevent the headaches. Medical Management Therapy for migraine headache is divided into abortive (symptomatic) and preventive approaches. The abortive approach, best used in those patients who have less frequent attacks, is aimed at relieving or limiting a headache at the onset or while it is in progress. The preventive approach is used in patients who experience more frequent attacks at regular or predictable intervals and may have a medical condition that precludes the use of abortive therapies (Starling, 2018). Medical management of migraine during pregnancy and lactation includes nonpharmacologic strategies in addition to safe medication practices. Nonpharmacologic treatments include mainly avoidance of triggers (Hickey & Strayer, 2020) (see Chart 61-8). Noninvasive neuromodulation devices may also provide some relief with minimal side effects (Tepper, 2019). The medical management of an acute attack of cluster headaches may include 100% oxygen by facemask for 15 minutes, subcutaneous sumatriptan, or intranasal zolmitriptan (Hickey & Strayer, 2020). The medical management of cranial arteritis consists of early administration of a corticosteroid to prevent the possibility of loss of vision due to vascular occlusion or rupture of the involved artery (Starling, 2018). The patient is instructed not to stop the medication abruptly, because this can lead to relapse. Analgesic agents are prescribed for comfort. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 3/5 10/24/23, 3:22 PM Realizeit for Student Nursing Management When migraine or the other types of headaches have been diagnosed, the goal of nursing management is pain relief. It is reasonable to try nonpharmacologic interventions first, but the use of medications should not be delayed. The first priority is to treat the acute event of the headache and the second is to prevent recurrent episodes. Prevention involves patient education regarding precipitating factors, possible lifestyle or habit changes that may be helpful, and pharmacologic measures. Relieving Pain Individualized treatment depends on the type of headache and differs for migraine, cluster headaches, cranial arteritis, and tension headache. Nursing care is directed toward treatment of the acute episode. A migraine or a cluster headache in the early phase requires abortive medication therapy instituted as soon as possible. Some headaches can be prevented if the appropriate medications are taken before the onset of pain. Nursing care during an attack includes comfort measures such as a quiet, dark environment; elevation of the head of the bed to 30 degrees; and symptomatic treatment (i.e., administration of antiemetic medication) (Hickey & Strayer, 2020). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 4/5 10/24/23, 3:22 PM Realizeit for Student Symptomatic pain relief for tension headache may be obtained by application of local heat or massage. Additional strategies may include administration of analgesic agents, antidepressant medications, and muscle relaxants. Promoting Home, Community-Based, and Transitional Care Educating Patients About Self-Care Headaches, especially migraines, are more likely to occur when the patient is ill, overly tired, or stressed. Nonpharmacologic therapies are important and include patient education about the type of headache, its mechanism (if known), and appropriate changes in lifestyle to avoid triggers. Regular sleep, meals, exercise, relaxation, and avoidance of dietary triggers may be helpful in avoiding headaches (Starling, 2018). The patient with tension headaches needs education and reassurance that the headache is not the result of a brain tumor or other intracranial disorder. Stress reduction techniques, such as biofeedback, exercise programs, and meditation, are examples of nonpharmacologic therapies that may prove helpful. The patient and family need to be educated about the importance of following the prescribed treatment regimen for headache and keeping follow-up appointments. In addition, the patient is reminded of the importance of participating in health promotion activities and recommended health screenings to promote a healthy lifestyle. Chart 61-8 presents educational topics for the patient with migraine headaches. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 5/5